Thromboelastography (TEG)
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Background
Tromboelastogram (TEG or ROTEM) is used to identify acute coagulopathies in both traumatic and nontraumatic patients. This enables focused use of blood products during resuscitation.
Features of a TEG Curve
- Initiation (R)
- Factor VIIa and Tissue Factor
- Amplification (K)
- Thrombin and activation of platelets
- Propagation (α-Angle)
- Thrombin burst
Normal Values
- R: 4-8 min
- K: 1-4 min
- α-Angle: 47-74°
Abnormal Values
- Prolonged R
- Factor deficiency or hemophilia
- Treat with FFP
- Prolonged K/Reduced α-Angle:
- Treat with cryoprecipitate
- Low MA: Platelets, desmopressin (DDAVP)
- Thrombocytopenia, platelet dysfunction (ASA)
- Treat with platelets or DDAVP
- Elevated LY 30%: Consider antifibrinolytics (aminocaproic acid, TXA)
- Treat with TXA
Abnormal K
Disposition
See Also
External Links
Sources
Walsh M, Thomas SG, Howard JC, et al. Blood component therapy in trauma guided with the utilization of the perfusionist and thromboelastography. Journal of Extra-Corporeal Technology. 2011 Sep; 43(3):162-7.